Appeals Case Manager II

At Guardian, you’ll have the support and flexibility to achieve your professional and personal goals. Through skill-building, leadership development and philanthropic opportunities, we provide opportunities to build communities and grow your career, surrounded by diverse colleagues with high ethical standards.

As the Appeals Case Manager II, Group Disability Claims you are responsible for adjudicating assigned appeals for Group Life and Disability claims. The ACM 2 provides a full and fair reconsideration review, as required under the Employee Retirement Income Security Act (ERISA), by thoroughly assessing the claim file and applying plan provisions in accordance with applicable state and federal regulations. This role supports Group Short-Term Disability, Long-Term Disability and Life Waiver of Premium appeals. You are: A highly motivated and reliable individual who is able to work with varying levels of supervision – independently or collaboratively. You are detail-oriented and a decisive decision maker who is able to manage multiple priorities at the same time with a positive attitude. Location: Remote/Flexible – work primarily from home. May be expected to come into a Guardian work location occasionally, as determined by their people leader. 0-10% possible travel.

Utilize effective claim management skills to plan, implement and execute the investigation of disputed claims; ensure timely and compliant appeal resolution. Identify and interpret relevant plan language and thoroughly investigate all claim issues to make an accurate and non-biased appeal determination. Evaluate medical, financial and other claim information in consultation with clinical/vocational professionals for the purpose of resolving disputes. Utilize proactive outreach to provide superior customer service to all internal and external customers. Identify legal and/or compliance scenarios that require additional research; facilitate resolution. Maintain current knowledge of all ERISA and Department of Labor guidelines. Independently prioritize workload based on individual and departmental deadlines. Readily share insights and learnings with claims colleagues.